Chart write-back: outreach as an encounter, document upload with a type, and why an upload cannot fulfil a measure

Start with ROADMAP §7.13 and §7.14, ADR-008, ADR-067, ADR-070, and docs/AI_GUARDRAILS.md §1. Confirm MIE's encounter, document, and order write APIs, document-type vocabulary, credential model, and developer access. Done means a scoped, human-approved write-back design that preserves CQL compliance decisions and audit_event requirements.

The most insistent ask of the 2026-08-27 working session — returned to three times — and it has never had an issue. Recorded as ROADMAP §7.13 on 2026-09-15.

The ask, in the practice's terms

Outreach should be documented in the chart as an encounter, with any resulting order in that same encounter. Stated at the time as "no tasks, everything encounters".

WorkWell built a task system: outreach, assignment and case state live in cases / case_actions and never leave. MM-4 covers ingest into WorkWell; nothing in MM-1→MM-4 covers documentation flowing back into WebChart. That gap has been unnamed for 19 days.

Related asks that need the same path:

• Document upload with a document type, from the 2026-09-10 call.
• Signature request on a generated document.
• Letter generation by document type, as the tail of the outreach ladder (separate issue).

The part that must be said to the practice, not silently dropped

The upload ask was phrased as uploading evidence with a document type that fulfils the measure. As stated that is not implementable, and not because of an integration gap: it collides with the non-negotiable rule that CQL decides compliance (LOCKED §4A.3, ADR-008, docs/AI_GUARDRAILS.md §1). A measure reads coded data and re-evaluates; a document attached in WorkWell changes nothing a measure can see, and a WorkWell-side flag that said otherwise would be the system asserting compliance it did not compute.

The two honest forms:

1. A coded result written back into the chart, which CQL then picks up on the next run — this issue.
2. MIE's order/document-code mapping (#7.1), so an uploaded document of a known type carries the code the measure's value set contains.

Either way the gap closes when the qualifying data arrives and CQL re-evaluates, never when a file is attached. This is on the owner's email list as an explanation owed to the practice.

What is needed from MIE

• The write API for encounters, documents and orders (FHIR Encounter/DocumentReference/ServiceRequest, or a WebChart-specific surface).
• The document-type vocabulary, and which types carry which codes.
• Whether a WorkWell-written encounter is acceptable in their chart at all, and under whose credentials.
• Developer access to verify any of it (ROADMAP §7.14).

Constraints that survive whatever the answer is

• An order is a proposal and never changes compliance (ADR-070 d3, ADR-067).
• No systemActions, no critical — nothing WorkWell returns may change a chart without a human choosing it.
• Every write still emits an audit_event.

Until this exists, the sandbox implies a patient was reached when the outreach never left WorkWell. The interim mitigation is a one-line "stays in WorkWell until the WebChart write-back ships" note on the outreach, appointment and upload controls, which is part of the next small customer-facing PR.

Related: #564 (appointments), ROADMAP §7.1, §7.13, §7.14.